Ligasure™ Impact and Ligasure™ Small Jaw in Body Contouring after Massive Weight Loss: A New Perspective.

BACKGROUND: The most effective dissection technique for elevating flaps in body contouring is still controversial, particularly in high-risk massive weight loss (MWL) patients. LigaSure (Medtronic, Dublin, Ireland) is an energy device commonly used among different surgical specialties to reduce morbidity and improve outcomes. The aim of this study is to investigate the effectiveness of LigaSure Impact and LigaSure Small Jaw in body contouring after MWL compared with conventional technique. MATERIAL AND METHODS: Patients who underwent abdominoplasty, mastopexy, brachioplasty and thigh lift after MWL at a single center from 1 December 2018 to 1 March 2020 were retrospectively reviewed. In each procedure patients were divided into two groups according to the dissection technique: LigaSure group and monopolar electrosurgery group. Patients characteristics, perioperative details and postoperative complications were evaluated. RESULTS: Fourty-five patients underwent abdominoplasty, twenty-six mastopexy, twenty brachioplasty and sixteen medial thigh lift. Using LigaSure, operative time was longer in abdominoplasty and thigh lift, but shorter in mastopexy and brachioplasty. Although not statistically significant, the amount of blood and serum recorded from drains in the first 36 hours was reduced in LigaSure groups. Additional analgesic intake was reduced with LigaSure as well as postoperative subjective pain. In all body contouring procedures statistically significant difference was found in days of hospital stay favoring LigaSure groups. Complications occurred most frequently in control groups compared to LigaSure groups. CONCLUSION: LigaSure Impact and LigaSure Small Jaw may be beneficial in improving outcomes because they might reduce fluids drainage, analgesics intake, hospital stay and postoperative complications.

Safety of autologous fat grafting in breast cancer: a multicenter Italian study among 17 senonetwork breast units autologous fat grafting safety: a multicenter Italian retrospective study.

BACKGROUND: Autologous fat grafting (AFG), defined as the re-implant to the breast of fat tissue from different body areas, has been firstly applied to esthetic plastic surgery and then has moved to reconstructive surgery, mainly used for scar correction and opposite breast altering. Nevertheless, due to the potentially unsafe stem-like properties of adipocytes at the tumoral bed level, no clear evidence of the procedure's oncological safety has been clearly documented at present. PATIENTS AND METHODS: We retrospectively collected data of early breast cancer (BC) patients from 17 Italian Breast Units and assessed differences in terms of locoregional recurrence rate (LRR) and locoregional recurrence-free survival (LRFS) between patients who underwent AFG and patients who did not. Differences were analyzed in the entire cohort of invasive tumors and in different subgroups, according to prognostic biological subtypes. RESULTS: With a median follow-up time of 60 months, LRR was 5.3% (n = 71) in the matched population, 3.9% (n = 18) in the AFG group, and 6.1% (n = 53) in the non-AFG group, suggesting non-inferiority of AFG (p = 0.084). Building Kaplan-Meier curves confirmed non-inferiority of the AFG procedure for LRFS (aHR 0.73, 95% CI 0.41-1.30, p = 0.291). The same effect, in terms of LRFS, was also documented among different biological subtypes (luminal-like group, aHR 0.76, 95% CI 0.34-1.68, p = 0.493; HER2 enriched-like, aHR 0.89, 95% CI 0.19-4.22, p = 0.882; and TNBC, aHR 0.61, 95% CI 0.12-2.98, p = 0.543). CONCLUSIONS: Our study confirms in a very large, multicenter cohort of early BC patients that, aside the well-known benefits on the esthetic result, AFG do not interfere negatively with cancer prognosis.

Optimization of Prepectoral Breast Reconstruction.

INTRODUCTION: Acellular dermal matrix (ADM) were introduced in the early 2000s and more recently permitted new protocols for breast reconstruction allowing a short operative time with improved outcomes until the new muscle-sparing breast reconstruction proposed in 2014 using the Braxon® ADM. The aim of this research is to propose a technique to improve the aesthetic outcome using Braxon ADM with prepectoral implants. MATERIALS AND METHODS: The enrolled patients were submitted to a nipple skin-sparing mastectomy leaving 1 additional centimeter of subcutis on the proximal part of the upper pole of the breast (see Surgical Technique). Aesthetic outcomes were compared to those obtained with traditional breast reconstruction with prosthesis and the Braxon ADM placed in the prepectoral space. Mean values of aesthetic outcomes were analyzed using the Student t test, and the κ test was used to analyze interobserver variability. RESULTS: The overall aesthetic score was improved of 29.6% of the patients; in particular the most improved score was that for contour (+98.01%). Statistical significance was found for contour, upper pole definition, and total score average (p < 0.05). The κ test showed interobserver variability with a good level of agreement on contour (κ = 0.832). CONCLUSIONS: The proposed technique has allowed attainment of good results in terms of aesthetic outcomes. In a small sample we did not register any particular complications but we verified a better satisfaction on the evaluation of the aesthetic result (level of evidence: 3).

Ultraportable Devices for Negative Pressure Wound Therapy: First Comparative Analysis.

Background: The author proposes to compare ultraportable devices for Negative Pressure Wound Therapy. Main reviews in literature assert that there is a lack in data about this topic. Materials and Methods: The study was conducted in 3 phases. The first phase involved a deep study of all the characteristics and indications of the ultraportable devices for available NPWT, highlighting dimensions, type of canister, functioning, mmHg negative pressure, the modality of use. The second phase was clinical: we treated 125 patients and described our 2 years experience. We treated the first 25 patients with PICO; then, second 25 patients with Nanova, then Uno, VacVia, and Snap in order to obtain 5 group of 25 patients. The third phase of the study consisted in the collection of data of scientific literature on classic and ultraportable devices: other experiences, multicentric studies, case reports, new suggestions, and other data on the topic were analyzed providing a synthesis of all available information. We made a diagram in order to summarize our experience and to compare the devices. Results: We described the main characteristics, main advantages and disadvantages of all devices. The literature data allowed us to investigate better to these aspects and to confirm the lack in comparing ultraportable negative wound pressure devices. Conclusions: All ultraportable devices have singular characteristics. Physician who want to use them, must know them in order to made appropriate therapy.

Aspiration Pneumonia: a Shadow in Post-Bariatric Patient : Correlation between aspiration and minigrastric bypass.

BACKGROUND: The number of post-bariatric surgical procedures is increasing in time. Post-bariatric patients must be carefully evaluated preoperatively, and they must be considered a particular group of patients in plastic surgery. Aspiration is an occurrence in surgical patients that can cause transient pneumonitis but, in some cases, it can progress to severe clinical acute lung injury or in acute respiratory distress syndrome. The aim of this research is to underline a correlation between one anastomosis bypass-minigastric bypass (OAGB-MGB) and biliar or gastric aspiration. METHODS: We performed an analysis of literature and a systematic review of our post-bariatric patients who underwent body contouring procedures which required general anaesthesia from 2013 to 2018 and divided them in two groups: OAGB-MGB group and other bariatric procedures in order to compare the rate of aspiration/pneumonia occurred in time. RESULTS: We collected 423 patients for 536 procedures and 9 complications. In the OAGB-MGB group, there was the highest rate of reflux/aspiration during anaesthesia induction (3.5%, 8 patients) compared with the other group (0.51%). Risk ratio of OAGB-MGB group vs other procedures is 7.054. Literature confirmed high risk of biliar reflux after OAGB-MGB procedure. CONCLUSIONS: This study underlined a significant correlation between OAGB-MGB and reflux/starting general anaesthesia in post-bariatric patients. In our experience we believe that it can be useful enlarge the pre-operatory fasting period and positioning a nasogastric tube during anaesthesia induction that can be performed moreover, in anti-Trendelenburg position, in order to prevent pulmonary aspiration.

Merkel Cell Carcinoma of the Cheek.

Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer with a neuroendocrine phenotype. Here, the authors reported a case of MCC, presented as a rapidly growing, asymptomatic, erythematous nodule measuring 3.8 cm × 2.8 cm in diameter on the right cheek of an 85-year-old Caucasian woman. After resection of the nodule, the defect was repaired with cutaneous graft taken from the supraclavicular area and healed uneventfully. Histopathologic examination confirmed the diagnosis of MCC.

Cellulite treatment: a comprehensive literature review.

An effective and long-term treatment of cellulite has not been well established. To our knowledge, no review has analyzed the whole range of treatments for this condition. We conducted a review of in vivo studies on humans adopting the key words "cellulite" and "treatment." The studies were included according to eligibility criteria. We performed an analysis to estimate the overall effect of cellulite treatments from clinical studies. Medline library was screened up to December 2014 to identify eligible studies. We included 73 original studies in the present review. All of them were clinical studies, in most of them, only women were recruited. Above the studies searched up, 66 tested the effectiveness of an exclusive treatment performed without the association to other procedures: 11 topical agents, 10 shock-wave therapy, 10 radio frequency, eight laser therapy, five oral therapy, four manual massage therapy, three carbon dioxide therapy, two compressive therapy, two infrared therapy, one dermabrasion, and 11 devices that use an association of multiple treatments. Seven papers tested a combination of two or more treatments. The mean difference of clinical morphologic features and ultrastructural changes between the treated group and the controlled showed significant heterogeneity between studies. It is still difficult to indicate an exclusive and effective single treatment for this condition. Our analysis purposed to obtain a complete overview of the available treatments in cellulite reduction.

EMLA and Lidocaine Spray: A Comparison for Surgical Debridement in Venous Leg Ulcers.

Objective: In this study the author proposes to compare eutectic mixture of local anesthetics (EMLA) and an odontoiatric spray solution of 10% Lidocaine (Ecocain) for surgical debridement in venous leg ulcers. Approach: Fifty patients were recruited and randomly assigned into two groups (A, B). All of them have venous leg ulcer in the medial and/or lateral malleolar region. Group A: topical anesthetic EMLA with film occlusion. Group B: topical anesthesia with Ecocain. The author proceeded to surgical debridement after local anesthesia. A questionnaire and a visual analog scale (VAS) were administered to assess the amount of pain felt during the debridement and during the following 6 h. Results: The analysis of the VAS revealed no major significant differences statistically. The analysis of the questionnaires showed patients treated with Ecocain took more analgesic drugs. Analysis of the timing and quality of procedure showed that Ecocain reduced the timing of debridement and dressing change, improving the outpatient management and patient compliance. Innovations: For rapid debridement, the most appropriate is to use Ecocain. Conclusion: Methods of local anesthesia are multiple and must be identified according to the needs of the patient and the surgeon trying to get the best anesthesia with minimal use of time and resources.

Complications Associated With Medial Thigh Lift: A Comprehensive Literature Review.

Medial contouring of the thigh is frequently requested to improve appearance and function of medial thigh deformities, following massive weight loss or aging process. This surgical procedure can be associated with a significant rate of complications. Our aim was to consider the complications and outcomes according to the performed technique, through a wide and comprehensive review of the literature. A search on PubMed/Medline was performed using "medial thighplasty", "medial thigh lifting" and "technique" as key words. As inclusion criteria, we selected the clinical studies describing techniques of medial thighplasty. We excluded the papers in which complications related to medial thighplasty were not specified. We also excluded literature-review articles. We found 16 studies from 1988 to 2015. Overall, 447 patients were treated. Different techniques were applied. Complications were observed in 191/447 patients (42.72%). The most frequent complications were wound dehiscence(18.34%) and seroma (8.05%). No major complications, such as thromboembolism and sepsis, were observed. Minor complications occurred in a high percent of patients, regardless of the performed surgical procedure. Patients should be informed about the possible occurrence of wound dehiscence and seroma, as common complications associated with this surgical procedure.

Postsurgical pain related to breast implant: reduction with lipofilling procedure.

BACKGROUND: After a review of clinical cases of the Unit of Plastic Surgery of the University of Siena, Italy, we found that 22 patients undergoing lipofilling for breast recontruction needed less pain drugs compared to 18 patients which did not undergo lipofilling. In this work, the postoperative pain was analyzed in two groups of patients: a cohort treated with prosthesis and a cohort treated with prosthesis implant together with a lipofilling procedure. PATIENTS AND METHODS: During the immediate postoperative period, a visual analog scale for pain was submitted to every patient every eight hours until they were discharged, then every day for a week, every two days during the second week and once a week in the first three months. The administration of analgesics was also registered. RESULTS: Pain intensity was lower in the group treated with prosthesis and lipofilling. CONCLUSION: Fat transplant is a procedure well-tolerated by patients, resulting in a lower rate of pain.